Florence Unified School District No. 1 ARIZONA STATE TAX CREDIT CONTRIBUTION FORM Arizona law (ARS 43-1089.01) provides that an individual may claim a credit for making contributions or paying fees to a public school for support of qualified activities or programs. The credit is equal to the amount contributed or fees paid. However, a single taxpayer credit cannot exceed $200. For married taxpayers filing jointly, the credit cannot exceed $400. Qualified activities or programs include: • Extracurricular activities – defined as school-sponsored activities that may require enrolled students to pay a fee in order to participate. • Character education programs (A.R.S. §15-719) • Standardized testing fees for college credit or readiness, such as SAT, PSAT, ACT, advanced placement and International baccalaureate diploma tests • Preparation courses and materials for standardized testing • Career and technical education industry certification assessment • Cardiopulmonary resuscitation training pursuant to A.R.S. §15-718.01 ***THIS FORM MUST ACCOMPANY ALL TAX CREDIT CONTRIBUTIONS IF PAYMENT IS NOT SUBMITTED ONLINE.***

CONTRIBUTOR INFORMATION Date: Mailing Address: City:

(PLEASE PRINT CLEARLY)

Taxpayer Name: State:

Zip Code:

Phone:

Choose a location: Anthem K-8 Magma Ranch K-8 Florence High School Circle Cross Ranch K-8 Skyline Ranch K-8 Poston Butte High School San Tan Foothills High School Copper Basin K-8 San Tan Heights Mountain Vista Academy Florence K-8 Walker Butte K-8 OR General Extracurricular Activities – Area of greatest need identified by the District. Student’s Name (Please print clearly)

Qualified activity or program

PTP Fee* (Please circle)

Yes

No

Yes

No

Yes

No

Contribution Amount Non-Refundable and Non-Transferable

*PTP = Pay-to-Participate Fee for sports programs.

This form must accompany any contribution that is to be processed as a tax credit. Taxpayer understands that the contribution will be posted as indicated and is non-refundable and non-transferable once processed.

Taxpayer Signature: Thank you for your support of Florence Unified School District students! Payment Options: 1. Online payments: http://www.fusdaz.com/tax-credits 2. Payments at site: Bring a completed tax form to closest school and make payment using cash or credit/debit card. 3. Mail Payments: Complete tax credit form and mail your money order or cashier’s check to: Florence Unified School District Attn: Julie Cook, Finance P O Box 2850 Florence, AZ 85132

Revised 11.20.2017

For more information, please contact your School Administrator or Julie Cook at the District Office at 520-866-3516. For assistance with our online payment system, please contact Amy Campbell at 520-866-3507.